Panic, Suffocation False Alarms, Separation Anxiety and Endogenous Opioids

Progress in Neuro-Psychopharmacology and Biological Psychiatry Article in Press, Accepted Manuscript - Note to users

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doi:10.1016/j.pnpbp.2007.07.029
Copyright © 2007 Elsevier Inc. All rights reserved.

Panic, Suffocation False Alarms, Separation Anxiety and Endogenous Opioids

Maurice Preter^{a, ,} and Donald F. Klein^{b, 1,
a}New York State Psychiatric Institute Columbia University College of Physicians and Surgeons, 1160 Fifth Avenue, Suite 112 New York, NY 10029, USA
^bNew York State Psychiatric Institute Columbia University College of Physicians and Surgeons 1051 Riverside Drive, New York, NY 10032, USA
Received 23 February 2007; revised 24 July 2007; accepted 24 July 2007. Available online 9 August 2007.

Corresponding author. Tel.: +1 212 713 5336; fax: +1 212 713 5336.
¹ Tel.: +1 212 543 6249.

Review article

Panic, suffocation false alarms, separation anxiety and endogenous opioids

Maurice Preter a,⁎, Donald F. Klein b,1

a New York State Psychiatric Institute, Columbia University College of Physicians&Surgeons, 1160 Fifth Avenue, Suite 112, New York, NY 10029, USA

b New York State Psychiatric Institute, Columbia University College of Physicians&Surgeons, 1051 Riverside Drive, New York, NY 10032, USA

Received 23 February 2007; received in revised form 24 July 2007; accepted 24 July 2007

Abstract

This review paper presents an amplification of the suffocation false alarm theory (SFA) of spontaneous panic [Klein DF (1993). False suffocation alarms, spontaneous panics, and related conditions. An integrative hypothesis. Arch Gen Psychiatry; 50:306-17.]. SFA postulates the existence of an evolved physiologic suffocation alarm system that monitors information about potential suffocation. Panic attacks maladaptively
occur when the alarm is erroneously triggered. That panic is distinct from Cannon's emergency fear response and Selye's General Alarm Syndrome is shown by the prominence of intense air hunger during these attacks. Further, panic sufferers have chronic sighing abnormalities outside of the acute attack. Another basic physiologic distinction between fear and panic is the counter-intuitive lack of hypothalamic–pituitary–adrenal (HPA) activation in panic. Understanding panic as provoked by indicators of potential suffocation, such as fluctuations in pCO2 and brain lactate, as well as environmental circumstances fits the observed respiratory abnormalities. However, that sudden loss, bereavement and childhood separation anxiety are also antecedents of "spontaneous" panic requires an integrative explanation. Because of the opioid system's central regulatory role in both disordered breathing and separation distress, we detail the role of opioidergic dysfunction in decreasing the suffocation alarm threshold. We present results from our laboratory where the naloxone-lactate challenge in normals produces supportive evidence for the endorphinergic defect hypothesis in the form of a distress episode of specific tidal volume hyperventilation paralleling challenge-produced and clinical panic.

© 2007 Elsevier Inc. All rights reserved.

Keywords: Affective neuroscience; Endogenous opioids; Panic disorder; Respiratory physiology; Separation anxiety

Headache as a sole manifestation in nonconvulsive status epilepticus.

J Child Neurol. 2007 May;22(5):660-2.

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Headache as a sole manifestation in nonconvulsive status epilepticus.

Ghofrani M, Mahvelati F, Tonekaboni H.

Child Neurology Department, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. fmshamsa@yahoo.com.

Nonconvulsive status epilepticus may present with several manifestations, and many of them may not be obvious. The most important for the diagnosis of nonconvulsive status epilepticus is the electroencephalogram pattern. This is a case report of a 9-year-old boy with severe and continuous headache. He received chemotherapy for histiocytosis that was diagnosed when he was 3 years, 6 months years old. He had no evidence of central nervous system histiocytosis involvement or drug toxicity. He was diagnosed with nonconvulsive status epilepticus. The headache and electroencephalogram anomaly disappeared completely when anticonvulsant therapy began. Headache and seizure disorder may coexist, but this may be the first report of nonconvulsive status epilepticus with headache as a sole manifestation.

PMID: 17690080 [PubMed - in process]

Intensity and duration threshold for aerobic exercise-induced analgesia to pressure pain.

Arch Phys Med Rehabil. 2004 Jul;85(7):1183-7.

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Intensity and duration threshold for aerobic exercise-induced analgesia to pressure pain.

Hoffman MD, Shepanski MA, Ruble SB, Valic Z, Buckwalter JB, Clifford PS.

Department of Physical Medicine and Rehabilitation, Veterans Affairs Medical Center and Medical College of Wisconsin, WI, USA. martin.hoffman@med.va.gov

OBJECTIVE: To examine how exercise-induced analgesia is affected by the duration and intensity of aerobic exercise. DESIGN: Repeated-measures design. SETTING: Exercise science laboratory. PARTICIPANTS: Convenience sample of 12 healthy male and female volunteers (mean age +/- standard deviation, 32+/-9 y). INTERVENTIONS: Pain ratings were assessed before and at 5 and 30 minutes after treadmill exercise of 10 minutes at 75% maximal oxygen uptake (Vo(2)max), 30 minutes at 50% Vo(2)max, and 30 minutes at 75% Vo(2)max (randomized order and no less than 48 h between each bout). MAIN OUTCOME MEASURES: Pain ratings were measured on a visual analog scale at 10-second intervals during a 2-minute pressure-pain stimulus to the nondominant index finger. RESULTS: Pain ratings were significantly decreased (P<.05) from pre-exercise values 5 minutes after 30 minutes of exercise at 75% Vo(2)max but returned toward baseline by 30 minutes after exercise. There were no significant changes in pain ratings after 10 minutes of exercise or after exercise at 50% Vo(2)max. CONCLUSIONS: There are thresholds for both the intensity (>50% Vo(2)max) and duration (>10 min) of exercise required to elicit exercise analgesia.

Publication Types:

• Clinical Trial
• Randomized Controlled Trial
• Research Support, Non-U.S. Gov't
• Research Support, U.S. Gov't, Non-P.H.S.

PMID: 15241771 [PubMed - indexed for MEDLINE]

A pilot study of a yoga and meditation intervention for dementia caregiver stress.

J Clin Psychol. 2004 Jun;60(6):677-87.

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A pilot study of a yoga and meditation intervention for dementia caregiver stress.

Waelde LC, Thompson L, Gallagher-Thompson D.

Pacific Graduate School of Psychology, Palo Alto, CA 94303, USA. lwaelde@pgsp.edu

Twelve older female dementia patient family caregivers (eight Latinas and four Caucasians) participated in a six-session manualized yoga-meditation program (called Inner Resources) designed to help caregivers cope with stress. Pre/post comparisons revealed statistically significant reductions in depression and anxiety and improvements in perceived self-efficacy. Average minutes of weekly yoga-meditation practice were significantly associated with improvements in depression. The majority of caregivers found the intervention useful and reported subjective improvements in physical and emotional functioning. These findings suggest that Inner Resources may be a feasible and effective intervention for family caregivers and may improve affect, coping, physical well-being, and stress management. Copyright 2004 Wiley Periodicals, Inc.

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• Comparative Study

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Yoga Asana sessions increase brain GABA levels: a pilot study.

J Altern Complement Med. 2007 May;13(4):419-26.

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Yoga Asana sessions increase brain GABA levels: a pilot study.

Streeter CC, Jensen JE, Perlmutter RM, Cabral HJ, Tian H, Terhune DB, Ciraulo DA, Renshaw PF.

Division of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA. streeter@bu.edu

OBJECTIVES: The aim of this study was to compare changes in brain gamma-aminobutyric (GABA) levels associated with an acute yoga session versus a reading session. It was hypothesized that an individual yoga session would be associated with an increase in brain GABA levels. DESIGN: This is a parallel-groups design. SETTINGS/LOCATION: Screenings, scan acquisitions, and interventions took place at medical school-affiliated centers. SUBJECTS: The sample comprised 8 yoga practitioners and 11 comparison subjects. INTERVENTIONS: Yoga practitioners completed a 60-minute yoga session and comparison subjects completed a 60-minute reading session. OUTCOME MEASURES: GABA-to-creatine ratios were measured in a 2-cm axial slab using magnetic resonance spectroscopic imaging immediately prior to and immediately after interventions. RESULTS: There was a 27% increase in GABA levels in the yoga practitioner group after the yoga session (0.20 mmol/kg) but no change in the comparison subject group after the reading session ( -0.001 mmol/kg) (t = -2.99, df = 7.87, p = 0.018). CONCLUSIONS:These findings demonstrate that in experienced yoga practitioners, brain GABA levels increase after a session of yoga. This suggests that the practice of yoga should be explored as a treatment for disorders with low GABA levels such as depression and anxiety disorders. Future studies should compare yoga to other forms of exercise to help determine whether yoga or exercise alone can alter GABA levels.

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• Clinical Trial
• Comparative Study
• Research Support, N.I.H., Extramural
• Research Support, Non-U.S. Gov't

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Irritable bowel syndrome and chronic pelvic pain: A singular or two different clinical syndrome?

World J Gastroenterol. 2007 Jul 7;13(25):3446-55.

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Irritable bowel syndrome and chronic pelvic pain: A singular or two different clinical syndrome?

Matheis A, Martens U, Kruse J, Enck P.

Department of Sychosomatic Medicine and Psychotherapy University Hospitals Tubingen, Frondsbergstr 23, Tubingen 72076, Germany. paul.enck@uni-tuebingen.de.

Irritable bowel syndrome (IBS) and chronic pelvic pain (CPP) are both somatoform disorders with a high prevalence within the population in general. The objective was to compare both entities, to find the differences and the similarities related to epidemiology and psychosocial aspects like stressful life events, physical and sexual abuse, illness behaviour and comorbidity. The technical literature was reviewed systematically from 1971 to 2006 and compared. According to literature, IBS and CPP seem to be one rather than two different entities with the same localisation of pain. Both syndromes also are similar concerning prevalence, the coexistence of mental and somatoform disorders, the common history of sexual and physical abuse in the past and their health care utilization. It could be shown that there were many similarities between IBS and CPP. Nevertheless both are traded as different clinical pictures as far. Therefore it seems to be reasonable and necessary to generate a common diagnosis algorithm and to bring gynaecologists and gastroenterologists into dialogue.

PMID: 17659691 [PubMed - in process]

Psychiatric Comorbidity in Epilepsy: A Population-Based Analysis.

Epilepsia. 2007 Jul 28; [Epub ahead of print]

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Psychiatric Comorbidity in Epilepsy: A Population-Based Analysis.

Tellez-Zenteno JF, Patten SB, Jetté N, Williams J, Wiebe S.

Division of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

Purpose: The estimated prevalence of mental health disorders in those with epilepsy in the general population varies owing to differences in study methods and heterogeneity of epilepsy syndromes. We assessed the population-based prevalence of various psychiatric conditions associated with epilepsy using a large Canadian national population health survey. Methods: The Canadian Community Health Survey (CCHS 1.2) was used to explore numerous aspects of mental health in persons with epilepsy in the community compared with those without epilepsy. The CCHS includes administration of the World Mental Health Composite International Diagnostic Interview to a sample of 36,984 subjects. Age-specific prevalence of mental health conditions in epilepsy was assessed using logistic regression. Results: The prevalence of epilepsy was 0.6%. Individuals with epilepsy were more likely than individuals without epilepsy to report lifetime anxiety disorders or suicidal thoughts with odds ratio of 2.4 (95% CI = 1.5-3.8) and 2.2 (1.4-3.3), respectively. In the crude analysis, the odds of lifetime major depression or panic disorder/agoraphobia were not greater in those with epilepsy than those without epilepsy, but the association with lifetime major depression became significant after adjustment for covariates. Conclusions: In the community, epilepsy is associated with an increased prevalence of mental health disorders compared with the general population. Epilepsy is also associated with a higher prevalence of suicidal ideation. Understanding the psychiatric correlates of epilepsy is important to adequately manage this patient population.

PMID: 17662062 [PubMed - as supplied by publisher]